A patient-level pooled analysis assessing the impact of the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score on 1-year clinical outcomes in 6,508 patients enrolled in contemporary coronary stent trials
Objectives: This study sought to assess the impact of the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (SXscore) on clinical outcomes in patients undergoing percutaneous coronary intervention. Background: The SXscore has been demonstrated to have an ability to predict clinical outcomes in patients undergoing percutaneous revascularization. Current studies are limited by the relatively small number of patients in each SXscore group. Methods: Patient-level data from 7 contemporary coronary stent trials were pooled by an independent academic research organization (Cardialysis, Rotterdam, the Netherlands). Analysis was performed on a cohort of 6,508 patients treated with drug-eluting stents and who had calculated SXscores. Clinical outcomes in terms of death, myocardial infarction (MI), repeat revascularization, and major adverse cardiac events (MACE, a composite of death, MI, and repeat revascularization) were subsequently stratified according to SXscore quartiles: SXscoreQ1≤8 (n = 1,702); 8 < SXscoreQ2<15 (n = 1,528); 15 ≤ SXscoreQ3≥23 (n = 1,620); and SXscoreQ4<23 (n = 1,658). Results: One-year outcomes were available in 6,496 patients (99.8%). At 1-year follow-up, all clinical outcomes including mortality, MI, repeat revascularization, MACE, and definite and any stent thrombosis were all significantly higher in patients in the highest SXscore quartile. Similar trends were observed in a subgroup of 2,093 patients (32.2%) who presented with an ST- or nonST-segment elevation MI. The rate of MACE among patients with an SXscore >32 and ≤32 was 24.9% and 14.0%, respectively (p < 0.001). The SXscore was identified as an independent predictor of all clinical outcomes including mortality, MACE, and stent thrombosis (p < 0.001 for all). Conclusions: This study confirms the consistent ability of the SXscore to identify patients who are at highest risk of adverse events.